In a single-center study, frailty tended to improve 6 months after, then worsen at 12 and 30 months (P<0.001). Patients over age 75 got more frail sooner -- within 6 months of coronary artery bypass grafting and medical therapy and after 6 months with percutaneous coronary intervention (PCI).

In a study of more than 1,700 people age 60 and older in Spain without pre-existing cardiovascular disease, patients who met two of the seven health metrics -- never smoking, physically active, healthy diet, body mass index under 25 kg/m2, cholesterol level under 200 mg/dL, blood pressure under 140/90 mm Hg, and fasting serum glucose under 100 mg/dL -- had about half the risk of frailty as those who met no more than one of those criteria over a mean follow-up of 3.5 years.

Gait Speed

A slow pace might flag being at high risk for cardiac surgery, analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database suggested.

"Gait speed is an independent predictor of adverse outcomes after cardiac surgery, with each 0.1-m/s decrease conferring an 11% relative increase in mortality," the researchers reported in JAMA Cardiology. "Gait speed can be used to refine estimates of operative risk, to support decision-making, and, since incremental value is modest when used as a sole criterion for frailty, to screen older adults who could benefit from further assessment."

In a survey of 21 physicians and 66 of their patients, 61% of the patients reported rarely or never discussing their medication adherence with their physician, even though almost 70% of these had poor or moderate adherence.

Only one of the physicians of the eight patients (13%) with the poorest adherence correctly identified that issue.

Fourteen physicians (67%) disagreed with the statement, "I am aware of how often my patient misses a dose of medication." By contrast, all of the physicians agreed that it is important for them to discuss adherence to medication with their patients.

"More important, our study found a notable failure by cardiologists to correctly recognize which of their patients were nonadherent," the researchers concluded in JAMA Cardiology, recommending that they "ask highly specific questions about adherence, such as 'How many heart drugs have you missed in the last 30 days?' at every patient visit."

Ischemic Outcomes in Women

A prior infarct spells a 2.84-fold higher risk of death in the subsequent 8.5 years among women with suspected ischemia and nonobstructive coronary artery disease, whereas ischemia on stress testing wasn't prognostic, a study showed.

The findings "underscore the need for heightened recognition of an adverse event profile in these women, the researchers concluded, based on their analysis of the WISE database, with 936 women getting clinically ordered coronary angiography for suspected myocardial ischemia and nonobstructive coronary artery disease from 1996 to 2000.

Over the past 15 years, mortality from acute myocardial infarction (AMI) has dropped across the country, an analysis showed. However, low-income counties are lagging about 4 years behind higher-income counties in acute hospitalization and mortality rates. "These findings lend support for a more targeted, community-based approach to AMI prevention," the researchers concluded in JAMA Cardiology.

Metabolic screening long recommended for second-generation antipsychotic medications is improving in some aspects, but not others, a retrospective analysis of Missouri's Medicaid data in the same journal showed. Annual testing rates were 79.6% for glucose and 41.2% for lipids. Failure to do these screens were most strongly associated with diagnosis of schizophrenia or bipolar disorder, cardiometabolic comorbidity, hypertension, and greater outpatient utilization.

And finally, proton pump inhibitors for heartburn also reduced acid production by endothelial cell lysosomes, which is required for their role as cellular "garbage disposals," and thus caused them to age rapidly, a lab study reported in Circulation Research, perhaps explaining why these drugs have been linked to heart disease.

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